This article provides a brief overview of the prevalence of tobacco smoking and the morbidity and mortality attributed to smoking. Information about the health system costs associated with smoking and the health status and demographic characteristics of smokers is included.

DATA SOURCES

This article uses data from the 2004-05 ABS National Health Survey (NHS), previous National Health Surveys from 1995 and 2001, and the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Estimates of deaths attributable to smoking which use ABS Causes of Death data are included. The article also draws on data from the 2004 National Drug Strategy Household Survey (NDSHS) (AIHW 2005).

Data were collected in the 2004-05 NHS from persons aged 18 years and over. In the 2004 NDSHS data were collected from persons aged 14 and over (with a small sample from 12-13 year olds). Both collections are household surveys which exclude homeless and institutionalised people, however the survey methodology and response rates in each survey were different.

INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070 or email <client.services@abs.gov.au>.

TOBACCO SMOKING

Tobacco smoking is the largest single preventable cause of death and disease in Australia (Cancer Council 2006).

Smoking is a key risk factor for the three diseases that cause most deaths in Australia: ischaemic heart disease, cerebrovascular disease and lung cancer. Smokers are also at increased risk of developing chronic obstructive pulmonary disease and reduced lung function (DoHA 2006).

Smoking in pregnancy increases the risk of health problems for both mother and child. (DoHA 2006).

Smoking is responsible for around 80% of all lung cancer deaths and 20% of all cancer deaths (smoking has been linked to cancers of the mouth, bladder, kidney, stomach and cervix, among others) (DoHA 2006).

The 2003 Australian Burden of Disease Study indicates that tobacco smoking was second behind overweight among the leading causes of burden of disease in Australia. It was estimated that tobacco smoking was responsible for about 8% of the total burden of disease and injury for all Australians (9.5% of total for males and 6.1% of total for females) (AIHW 2006: Begg et al in press).

SMOKING PATTERNS

In 2004-05, 23% of adults were current smokers, about 3.5 million persons (footnote 1).

21% of adults reported being regular daily smokers (representing 92% of smokers), while 2% reported smoking less frequently than daily.

30% of adults reported being ex-smokers and 47% reported never smoking regularly(footnote 2).

Rates of current smoking have decreased slightly for both men and women in recent years, based on age-adjusted estimates from the last three National Health Surveys (1995, 2001 and 2004-05)(footnote 3). Over the period 1995 to 2004-5 the estimated proportion of men who were current smokers changed from 28% to 26% , and the corresponding change for women was 22% to 20%, after adjusting for age differences (footnote 4).

Prevalence of current smoking (a)(b), 18 years and over

AGE AND SEX

In 2004-05, 26% of men and 20% of women were current smokers.

For both men and women, smoking rates are highest in younger age groups and decline with increasing age.

The highest rates of smoking for men were reported in the 18-24 years age group (34%) and for women in the 25-34 years age group (27%).

Prevalence of current smoking(a), 2004-05

There were decreases in age-specific rates for current smoking in many adult age groups over the period 1995 to 2004-05. In particular, decreases are evident in older age groups (65 years and over) for both men and women, and also in some younger age groups (particularly in the 18-34 year age group for women and the 25-34 year age group for men).

UNDER AGE SMOKING

People who start smoking when they are young are more likely to smoke heavily, to become more dependent on nicotine and to be at increased risk of smoking-related illness or death (McDermott, Russell and Dobson 2002) .

According to the 2004 National Drug Strategy Household Survey, males had their first cigarette at age 15.2 years on average and females at 16.5 years (of Australians aged 14 years and older who had ever smoked) (AIHW 2005).

12.7% of males aged 14 to 19 years were current smokers, compared to 14.2% of females (AIHW 2005).

PASSIVE SMOKING

The breathing in of tobacco smoke by non-smokers can lead to harmful health effects in the unborn child, and middle ear infections and bronchitis, pneumonia, asthma and other chest conditions in children. It is also linked to sudden infant death syndrome (SIDS). In adults, passive smoking can increase the risk of heart disease, lung cancer and other chronic lung diseases (Queensland Health 2006).

More than a third (37%) of children aged 0-14 years live in households with one or more regular smokers, while 10% of children 0-14 years live in households where there is at least one regular smoker who smokes indoors.

MORTALITY

Estimating the number of deaths due to tobacco smoking is difficult due to the fact that it is a risk behaviour for a wide range of diseases. The most recent estimates of deaths caused by tobacco were published by Ridolfo and Stevenson (2001). According to the study;

15% of all deaths (approximately 19,000 deaths) were due to tobacco smoking in 1998.

Of these, approximately 13,000 were male deaths and 6,000 were female deaths.

Most of these deaths (around 14,800) occurred at older ages, but a substantial number (around 4,200) occurred at ages under 65 years.

Cancer was responsible for 40% of these tobacco-related deaths, the majority of which were lung cancer.

A study which followed a cohort of male British doctors over 50 years has shown that cessation of smoking at any age will increase life expectancy. Specifically, cessation at age 60, 50, 40 or 30 years, gained about 3, 6, 9 or 10 years of life expectancy, respectively (Doll, Peto, Boreham and Sutherland 2004).

INDIGENOUS AUSTRALIANS

In 2004-05, half of adult Indigenous Australians (50%), were current daily smokers.

51% of Indigenous men and 49% of Indigenous women reported being current daily smokers.

Smoking was more prevalent among Indigenous than non-Indigenous adults in every age group. After adjusting for age differences, Indigenous adults were still more than twice as likely to be current daily smokers.

Smoking was associated with poorer health outcomes among Indigenous Australians in 2004-05. Current daily smokers were more likely than non-smokers to report being in fair or poor health (56% compared with 43%) and were less likely to report being in excellent or very good health (44% compared with 54%).

Daily smokers (a), 18 years and over, 2004-05

RISK FACTORS

Results from the 2004-05 NHS indicate that smoking tends to be reported alongside other lifestyle risk factors. Adult smokers had generally higher levels of risky/high risk alcohol consumption, lower daily fruit and vegetable intake and lower levels of exercise, than ex-smokers and those who reported never smoking.

An estimated 21% of current smokers reported drinking at risky or high risk levels, compared with 16% of ex-smokers and only 8% of those who reported never smoking, after adjusting for age differences.

Current smokers were also more likely to report fruit and vegetable intake which was under recommended levels. Approximately 63% of current smokers reported consuming less than two serves of fruit per day (the recommended daily intake), compared with 39% of those who had never smoked. Similarly 26% of current smokers reported consuming less than two serves of vegetables per day, compared with around 18% of those who had never smoked, after adjusting for age differences.

Adults who smoked also tended to report lower levels of exercise. Around 77% of current smokers reported either no exercise or a lowlevel of exercise, compared with 67% of ex-smokers and 69% of those who reported never smoking, after adjusting for age differences.

SOCIOECONOMIC STATUS

Socioeconomic status is known to be strongly associated with many health conditions and health risk factors, and this is particularly true of tobacco smoking. The rate of smoking is much higher in areas of socioeconomic disadvantage.

After adjusting for age differences, 33% of men and 28% of women in the most disadvantaged areas reported being daily smokers, compared to 16% of men and 11% of women in the most advantaged areas, as measured as being in the first or fifth quintiles of the Index of Relative Socio-Economic Disadvantage respectively (footnote 5).

Prevalence of daily smoking (a) by Index of Disadvantage, 2004-05

GEOGRAPHICAL AREAS

After adjusting for age differences, 33% of adults in Remote Australia reported being current smokers in comparison to 22% in Major Cities, 26% in Inner Regional and 28% in Outer Regional Australia (footnote 6).

COUNTRY OF BIRTH

Those born in Oceania and Antarctica (mainly Australia and New Zealand), Southern and Eastern Europe, and North West Europe were the most likely to report current smoking (24%, 23% and 22% respectively), after adjusting for age differences.

Those born in Southern and Central Asia, South-East Asia, and North-East Asia had the lowest proportions of current smokers (12%,15% and 16% respectively).

HEALTH STATUS

Overall, only 45% of current smokers reported very good or excellent health, compared to 57% of ex-smokers and 60% of those who reported never smoking, after adjusting for age differences. As well at any age, the proportion of current smokers who rated their health as fair or poor was substantially higher for each age group than that for those who never smoked .

Smokers also reported higher levels of psychological distress. About 20% of current smokers reported high or very high levels of psychological distress, compared to only 10% of those who had never smoked, after adjusting for age differences.

Smokers had higher levels of respiratory disease than those who had never smoked. For example, 4% of current smokers reported bronchitis and 11% reported asthma, after adjusting for age differences. Corresponding proportions for those who never smoked were lower at 2% and 9% respectively.

HEALTH SYSTEM COSTS

In 1997-98 an estimated 97,000 hospital separations for males, and 45,000 for females were attributable to tobacco (Ridolfo and Stevenson 2001).

For males, 29% of hospital separations attributable to tobacco were due to ischaemic heart disease, 21% due to cancer and 19% due to chronic obstructive pulmonary disease. 'Other direct smoking' causes which include atherosclerosis and stroke, accounted for 30% (Ridolfo and Stevenson 2001).

For females, 22% of hospital separations attributable to tobacco were due to chronic obstructive pulmonary disease, 19% due to ischaemic heart disease, and 14% due to cancer. 43% were due to 'other direct smoking' causes (Ridolfo and Stevenson 2001).

Of the total health care costs resulting from all forms of drug abuse in 1998-99, approximately 80% were attributable to tobacco. In that year costs attributable to tobacco were $1094.4 million net, including medical, hospital, nursing home and pharmaceutical costs (Collins and Lapsley 2002).

Savings associated with avoided deaths and related declines in illness and disability due to reduced tobacco use in Australia over the last 30 years are estimated to be approximately $8.6 billion (Ministerial Council on Drug Strategy 2004).

FOOTNOTES

1. The 2004-05 NHS classified adults' smoker status using four main categories: current daily smoker, current smoker - other, ex-smoker, and never smoked. 'Current smoker' includes those who reported smoking daily, weekly or less than weekly. Some under-reporting of current smokers is expected to have occurred due to perceived social pressures on respondents (particularly in cases where other household members were present at the interview). The extent to which under-reporting has occurred and hence its effect on the accuracy of survey estimates is unknown. For more information see National Health Survey: Users' Guide, 2004-05 - Electronic Publication, Australia(cat. no. 4363.0.55.001). Back

2. A smoker status of 'ex-smoker' in the NHS refers to an adult who reported they did not currently smoke, but had regularly smoked daily, or had smoked at least 100 cigarettes, or smoked pipes, cigars, etc. at least 20 times in their lifetime. A smoker status of 'never smoked' refers to an adult who reported they had never regularly smoked daily, had smoked less than 100 cigarettes in their lifetime, and had smoked pipes, cigars, etc. less than 20 times in their lifetime. New questions were included in the 2004-05 NHS about lifetime experience of smoking at least 100 cigarettes or pipes/cigars at least 20 times, to better define these 'ex-smoker' and 'never smoked' categories in line with National Health Data Dictionary and WHO guidelines. Back

3. Since many health characteristics are age-related, the age profile of the populations being compared needs to be considered when interpreting the data. To account for the differences in age structure, where noted, some estimates within this publication are shown as age standardised percentages, using the Australian estimated resident population at June 30 2001 as the standard population. Age groups 18-24, 25 to 34 ...75 years and over were used in the calculations. For further detail, see the Explanatory Notes of the National Health Survey: Summary of Results, 2004–05 (cat. no. 4364.0). Back

4. Results for age-standardised prevalence of current smoking from the 1995 NHS presented in this article have been revised and are slightly different from those published previously in National Health Survey: Summary of Results, 2004–05 (cat. no. 4364.0). Back

5. The Index of Relative Socio-Economic Disadvantage is one of four Socio-Economic Indexes for Areas (SEIFA) compiled by ABS following each Census of Population and Housing. The indexes are compiled from various characteristics of persons resident in particular areas; the index of disadvantage summarises attributes such as low income, low educational attainment, high unemployment and jobs in relatively unskilled occupations. For further information on the Index of Disadvantage, see Chapter 6 of National Health Survey: Users' Guide - Electronic Publication, 2004-05, Australia (cat. no. 4363.0.55.001). Back

6. The Australian Standard Geographical Classification (ASGC) Remoteness Structure has 5 categories based on an aggregation of geographical areas which share common characteristics of remoteness, determined in the context of Australia as a whole. These categories are: Major cities of Australia, Inner regional Australia, Outer regional Australia, Remote Australia and Very remote Australia. The five categories are generally aggregated in some way for use in output. The delimitation criteria for these categories are based on the Accessibility/Remoteness Index of Australia (ARIA) developed by the Commonwealth Department of Health and Aging and the National Key Centre for Social Applications of GIS (GISCA). ARIA measures the remoteness of a point based on the physical road distance to the nearest Urban Centre. For more information see Australian Standard Geographical Classification (ASGC), 2001 (cat. no. 1216.0). Back